Douglas J. Rhee, MD

132APPENDIX 6. TITRATING TOPICAL DROPS FOR CHILDREN 1This table is given to help the clinician estimate how to adjust the adult eye drop dose for pediatric aged patients. Due to the infantssmaller blood volume, systemic levels of topically applied drops can be very high compared to the adult. One study showed that infantsusing timolol maleate 0.25% had up to 25 times the adult plasma level. 2 Other considerations when attempting to limit systemic adsorptionin children are:1. Start with lower concentrations when therapeutically warrented and the alternative exists. (example timolol maleate 0.25% insteadof 0.5%)2. Use passive lid closure and digital pressure over the canalicular drainage system when possible to limit access to the nasalmucosa.It is important to note that this table is not applicable to all children. Body weight, metabolic function, and concomitant medicationsshould also be taken into account.Age Fraction of adult dosebirth – 2 years old 50%2–3 years old 67%3–7 years old 90%7–12 years old 95%>12 years old full dose1 Adapted from Abelson MB, Paradis A, Grant KK. How to prescribe for the smallest sufferers. Rev Ophthalmol 1999;2:101–103.2 From Ophthalmology 1984;91:1361–1363.